Prevalence, lifestyle, and risk factors of erectile dysfunction, premature ejaculation, and low libido in middle-aged men: first results of the Bavarian Men's Health-Study

Background: Erectile dysfunction (ED), premature ejaculation (PE), and low libido (LL) are reported as the most common male sexual dysfunctions. Objective: To evaluate the prevalence of ED, PE, and LL and associations with lifestyle risk factors and comorbidities in middle-aged men. Materials and methods: This study included a population-based random sample of 2500 50-year-old men who completed validated questionnaires, including the International Index of Erectile Function, the Erection Hardness Score, the Sexual Complaints Screener, and further questionnaires. Multiple logistic regression of outcomes ED, PE, and LL was used to model the association with explanatory factors. Results: The prevalence of at least one sexual dysfunction was 30%. 21%, 5.2%, and 7.2% of men had ED, PE, and LL, respectively. The risk of ED increased with PE (odds ratio [OR]: 1.94, 95% confidence interval [95%CI]: 1.22–3.08), LL (OR: 2.04, 95%CI: 1.26–3.29), higher waist circumference (OR: 2.23, 95%CI: 1.67–2.96), and lower urinary tract symptoms (LUTS) (OR: 1.88, 95%CI: 1.39–2.55), partnership was associated with a lower risk (OR: 0.57, 95%CI: 0.39–0.85). The risk of PE increased with ED (OR: 1.94, 95%CI: 1.23–3.07), partnership (OR:5.42, 95%CI: 1.30–22.60), depression (OR: 2.37, 95%CI: 1.09–5.14), and LUTS (OR: 2.42, 95%CI: 1.52–3.87), and decreased with physical activity (OR: 0.44, 95%CI: 0.21–0.93). The risk of LL increased with ED (OR: 2.09, 95%CI: 1.31–3.34) and poorer self-rated health (OR: 2.97, 95%CI: 1.54–5.71). Discussion and conclusions: Roughly one in three 50-year-old men experience some form of sexual dysfunction and risk factors identified in this study underline the multifactorial nature of ED, PE, and LL. Many risk factors are modifiable which underlines the role of patient education. Modifiable risk factors should be addressed in patient education and men should take active measures to remove the risk posed by these factors.